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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

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  Editorial …

26th May 2013, Sunday

Do not ignore warning signals

Often people ignore warning signals and do not address them until they fall ill, often with grave consequences. Here are certain rules that you should follow.

  • Never ignore any symptom or sign, which has occurred for the first time, unexplained or unusual.
  • If you run and then get exhausted, this exhaustion is understandable. But if you get up exhausted after hours of rest, this needs to be investigated.
  • The first episode of acidity after the age of 40 can be a heart attack.
  • Acidity usually starts in young age but if it occurs after the age of 40 years, the symptoms may indicate underlying heart disease.
  • You have been getting headaches for years but if the present episode of headache is unusual, severe and unexplained, you need immediate medical attention.
  • It is expected whenever you go to your doctor for a particular disease, they may warn you about the following:
    • Signals for emergent attention mean to call the doctor right away.
    • Symptoms for urgent attention mean to contact the doctor same day.
    • Symptoms for attention mean doctor to be informed in the next visit.
  • One should be able to differentiate emergent from urgent symptoms and signs. Emergency warrants medical attention within minutes.
  • The window period for cardiac arrest is 10 minutes, for heart attack 3 hours, for stroke 3 hours and for stoppage of bleeding 1 hour.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Vitamin D intake associated with reduced risk for Crohn’s disease

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2013

Heart Care Foundation of India and World Fellowship of Religions in association with Ministry of Earth Sciences Govt. of India and Delhi Public School Mathura Road observed World Earth Day 2013.

Dr K K Aggarwal
    National News

Four of 10 cancer cases due to tobacco abuse

New Delhi: In India, four out of every 10 new cancer cases are tobacco-related as reported in the TOI. If stringent measures to check the usage of bidi, cigarette and gutka — the most commonly used tobacco products — are not taken, then the number of people affected by the disease will increase three-fold, say medical experts.

According to Dr P K Julka, professor and head of the oncology division at All India Institute of Medical Sciences (AIIMS), most of the tobacco-related cancer involves young people, particularly men. "Such cases are increasing among women also," Julka said while speaking at Dialogue on Cancer and Tobacco, a seminar organized by The Times of India under the banner of Times Wellness for World No Tobacco Day on May 31. The event was attended by cancer experts like Dr Ashok Vaid, chairman, Cancer Institute, division of medical oncology and hematology at Medanta Medicity; Dr Shyam Agarwal, chairperson, medical oncology at Sir Ganga Ram Hospital and Dr Ranga Rao, director medical oncology at B L Kapur Memorial Hospital. Dr Monika Arora, director, health promotion and tobacco control at the Public Health Foundation of India and Dr Anurita Majumdar, the medical director of Eli Lilly Ltd were also present. There is a growing trend of using hookah among youngsters, Vaid said. "Tobacco in hookah is no less toxic. It is a misconception that the water-base or waterpipe in hookah filters the toxic ingredients," he added. Awareness about its harmful effects needs to spread further. "Having a chapter in the school curriculum, roping in celebrities to spread the word, and ensuring strict compliance of the warning labels of tobacco products, is needed," said Agarwal.

Tobacco-related cancers are estimated to be approximately 56.4% and 44.9% for male and females respectively. Tobacco causes cancer of the lung, larynx, oesophagus, pharynx and cervix. Globally, 6 million people die due to tobacco consumption-related diseases each year. The death toll is estimated to rise to eight million by 2030, according to a recent data. (Source: TOI, May 25, 2013)

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DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, Telecast every Wednesday 9 AM in DD National

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Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

Echocardiography screening is recommended for children and young adults. One should take a history for prior acute rheumatic fever, perform echocardiography in all, and then clinical cardiac evaluation of cases with abnormal echocardiography.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Sexual dysfunction in obsessive compulsive disorder and panic disorder

The study population consisted of 80 patients between 20 and 60 years of age with a diagnosis of OCD or PD who were followed and treated at the anxiety outpatient unit of Bakirkoy Research and Training Hospital for Psychiatric and Neurological Disorders between 2005 and 2006. The total study population comprised of 40 patients with OCD, 40 patients with PD, and 40 healthy volunteers as the control group. Of the two questionnaires used for study purposes, the first provided information on demographic data and certain parameters of sexual functioning, while the second was the validated Turkish translation of the Golombok-Rust Sexual Satisfaction Inventory with transliteral equivalence.

Male subjects with OCD had a lower age of first masturbation and first nocturnal ejaculation. Infrequency problem among female and male patients with OCD occurred in 63.6% and 57.1%, respectively. Corresponding figures for PD patients were 36% and 38%. Thus, infrequency problem was more frequent among OCD patients. Sexual avoidance was found in 60.6% of female OCD patients and in 64% of female PD patients. Anorgasmia was detected in 24.2% of the female subjects with OCD.

(Source: Aksoy UM, et al. Psychiatr Danub. 2012 Dec;24(4):381-5).

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Kidney Disease: Healthy heart lifestyle may slow progression

To protect against chronic kidney disease (CKD) progression and premature death from kidney failure, it might be wise to look at the heart. An article published online May 23 in the Journal of the American Society of Nephrology suggests that improving heart health can also be protective against CKD progression. (Source: Medscape)

For comments and archives

Adults with CF need close colon cancer screening

With cystic fibrosis (CF) patients now living well into adulthood they are at risk for developing adenomatous colon polyps and should be screened early and often, researchers said at the Digestive Disease Week. (Source: Medpage Today)

For comments and archives

Plecanatide eases chronic constipation

Results from a 12-week multicenter placebo-controlled study have shown that for some patients with chronic idiopathic constipation, the number of complete spontaneous bowel movements improved after treatment with plecanatide. Plecanatide belongs to a new class of oral agents, known as guanylate cyclase-C receptor agonists. These mimic the effects of the natriuretic peptide uroguanylin and induce intestinal fluid secretion into the lumen of the gastrointestinal tract. (Source: Medscape)

For comments and archives

Azithromycin may reduce COPD flare-ups

Long-term antibiotic treatment of patients with chronic obstructive pulmonary disease (COPD) may prolong the time it takes for the disease to exacerbate, researchers suggested at the American Thoracic Society meeting. (Source: Medpage Today)

For comments and archives

HRT Use: New guidelines from the British Menopause Society

The British Menopause Society (BMS) and Women's Health Concern has issued updated guidelines on hormone replacement therapy (HRT) to clarify its use, benefits, and risks. The new recommendations, intended to complement the BMS Observations and Recommendations on menopause, were published online May 24 and in the June print issue of Menopause International. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Heart Patients Beware of Summer http://bit.ly/13KOwPI #Health

@DeepakChopra: When is the best time to do meditation? http://tinyurl.com/kvpsyup #askdeepak

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Why do we close our eyes during pooja?

Whenever we pray, think of God, undertake an internal healing procedure like meditation, or even when we make love or kiss someone, we automatically close our eyes. It is a Vedic saying that the soul resides in the heart and all the feelings are felt at the level of heart.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Is fertility possible after cancer treatment?

  • Men: If sperm counts are consistently low, insemination, IVF, and ICSI may be effective measures for achieving pregnancy. Testicular biopsy may be a way to obtain sperm if sperm are not found in a semen analysis. If sperm cannot be obtained, pregnancy may be possible by using frozen donor sperm.
  • Women: Many women will be able to conceive naturally or with fertility treatments. If significant damage has occurred to the ovaries or uterus, couples may wish to consider egg or embryo donation, a gestational carrier, or adoption to create a family.
    An Inspirational Story

The Cookie Thief

A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop. She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be. . .grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene.

So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, “If I wasn’t so nice, I would blacken his eye.”

With each cookie she took, he took one too, when only one was left; she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half. He offered her half, as he ate the other; she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude!

She had never known when she had been so galled and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate.

She boarded the plane, and sank in her seat, and then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes.

If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.

For comments and archives

    Cardiology eMedinewS

Daughters of smoking mothers have more gestational diabetes
Read More

    Pediatric eMedinewS

Pertussis vaccines: Whole-cell more durable than acellular Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

A person has handled or eaten the raw meat of a rabid animal. What should be done?

If a person has handled or eaten the raw meat of a rabid animal, he should receive full course of rabies vaccine. If the person has eaten raw meat of a rabid animal and has oral ulcers/lesions, he may be given RIGs intramuscularly in thigh on Day 0 along with the first dose of vaccine.

    IJCP Special

Dr Good Dr Bad

Situation: A 32–year–old man with sustained fever of 102°F for 2 weeks with no apparent diagnosis after 3 days of diagnostic studies is hospitalized.
Dr Bad: Manage him as a case of PUO.
Dr Good: Investigate further. Don’t diagnose PUO yet.
Lesson: Pyrexia of unknown origin (PUO) is said to occur in patients with sustained fever of 101°F or more for 3 weeks in whom the diagnosis is not apparent after one week of diagnostic studies.

Make Sure

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.

    Quote of the Day (Dr GM Singh)

Many people love in themselves what they hate in others. E. F. Schumacher

   Mind Teaser

Read this…………………

Nurse Lea is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

a. Rashes on the palms of the hands and soles of the feet
b. Cauliflower-like warts on the penis
c. Painful red papules on the shaft of the penis
d. Foul-smelling discharge from the penis

Yesterday’s Mind Teaser: A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
b. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days.
c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.
d. The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex.

Answer for Yesterday’s  Mind Teaser: a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

Correct answers received from: Dr Valluri Ramarao, Dr Jayashree Sen &
Dr Bitaan Sen, Tukaram Pagad, Daivadheenam, Dr(Brig) C H Gidvani,
Dr Gajveer, Dr BB Gupta, Dr (Maj. Gen.) Anil Bairaria, Dr Anirban Hom Choudhuri, Dr Arpan Gandhi, Dr Pankaj Agarwal, Dr Jainendra Upadhyay,
Dr Thakor Hitendrsinh G, Dr Chandresh Jardosh, Dr PK Sahu, Dr KV Sarma,
Dr Vineet jain, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Raju Kuppusamy.

Answer for 24th May Mind Teaser: d. HIB, DTP, HepB; and IPV

Correct answers received from: Dr KV Sarma, Prof P Suvarna Devi.

Send your answer to ijcp12@gmail.com

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   Laugh a While (Dr GM Singh)

The Football Player

There was a football coach that had a player on his team who was a bit slow.

The Headmaster told him that if the player could learn the formula for water, then he would be allowed to play in the big game.

The day of the big game came and the Dean called the player into his office and asked him to recite the formula for water.

The player grinned real big and said, 'H I J K L M N O.'

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

The right to refuse medical interventions - The Nancy Vehicle Accident Case

The US Supreme Court declared that artificial hydration or nutrition is no different from medicines

Nancy Cruzan, a 31–year–old woman suffered severe brain damage in a vehicular accident that placed her in a persistent vegetative state, dependent upon a feeding tube.

  • After four years without improvement in her cognitive function, her family asked to have her artificial feeding and hydration stopped.
  • In its decision, the United States Supreme Court recognized that competent patients have a constitutional right to refuse medical care.
  • Using the Fifth Amendment’s guarantee that no person shall "be deprived of life, liberty, or property, without due process of law" the Supreme Court affirmed patients’ rights to refuse medical treatments. The Court declared that artificial hydration or nutrition is no different from other medical interventions. Although mentally incapacitated patients have the same right, the Supreme Court allowed states to impose restrictions on how explicit and specific the patient’s prior wishes had to be.
  • After this court ruling, some of Cruzan’s friends provided evidence that she had previously expressed wishes that she would want artificial feedings discontinued in such a scenario. As a result of this testimony, her feedings were terminated.
  • Mentally competent patients need not be terminally ill to exercise this right to refuse interventions they have the right regardless of health status.
  • The right applies equally to withholding proposed treatments and to discontinuing initiated treatments.
  • The right to refuse medical care does not imply a correlative right to demand treatment.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Heat index should be communicated to the public

‘Heat index’ measures the combined effects of temperature and humidity on the ability of the body to lose heat. It determines how hot it really feels. Periods of high heat index adversely affect human health.

Elaborating on this, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA explained that the human body normally cools itself by sweating through evaporation, which carries heat away from the body. But, high relative humidity reduces the evaporation rate and so heat is removed from the body at a lower rate causing it to retain more heat than it would in dry air. As a result, the body temperature increases leading to heat-related illnesses such as heat exhaustion, heat cramps and heat stroke.

‘Heat cramps’ is the mildest form of heat disorder, presenting with cramps due to salt and water dehydration. ‘Heat exhaustion’ is a milder form of heat disorder where sweating is still present. But, ‘heat stroke’ can be lethal if not diagnosed and treated in time. Patients with heat stroke manifest with high fever, dehydration and absence of sweating. The rectal temperature often shoots more than 106°F. Oral and axillary temperatures may not be reliable in such situations. The affected person may be dehydrated to up to 8 to 10 liters of fluid.

This summer, with temperatures already crossing 45°C, heat-related disorders are likely to increase.

Sportspersons should avoid workouts during peak sun hours and should take adequate fluids to prevent dehydration. Salted lemon water and mango ‘panna’ are the drinks of choice.

  • Heat stroke is common in elderly and in people who take anti-allergic tablets.
  • Altered consciousness in a patient with fever should make lead to the suspicion of underlying heat disorders.
  • One may lose 500 to 1000 ml of fluids everyday due to summer sweating. This amount, therefore, may need to be taken extra. However, patients with kidney diseases or heart failure need to consult their doctors to decide the amount of extra fluid they need to take.
  • Absence or presence of sweating can be detected by armpit test. A dry armpit may mean severe dehydration.
  • In summer, everyone should pass urine once in 8 hours. Not passing urine in 8 hours may mean severe dehydration.
  • One should avoid eating cut fruits and vegetables that are sold open during this season to prevent disorders like jaundice, typhoid, gastroenteritis and cholera.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 50457 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Responses
  1. Dear Sir, Emedinews is very useful, Dr Krishna
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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